Should measles vaccination be mandated?
They lost their son after a long battle.
“I`ll never forget my parents coming back from the doctor. They had been told that Max had subacute sclerosing panencephalitis (SSPE), a fatal result of measles infection for which there is no cure.
They were also told that he had two or three weeks to live. It was devastating.”
Max and his brother Julian had lived a normal early childhood; school, ice hockey, playing, and other outings. They were a typical busy, bustling family.
However, when Max was 6 months old, something happened that would change the family's lives forever. Max caught measles. He was too young to receive the MMR vaccine, which is generally given at 1 year old, and boosted at 4 to 5 years of age. After enduring a high fever and difficulty breathing for a few weeks, Max had recovered…..
Or so it appeared…
9 years later, Max began having difficulty balancing, performing at school, and had seizures. After progressively detioriating, Max was diagnosed with SSPE. It generally occurs 7-10 years after the initial measles infection. Eventually, Max`s condition deteriorated so much that he had to be placed in a hospice. Soon after, he died. Since then, Julian and his parents have thrown themselves into raising awareness about the impact of measles, and hope their story will encourage others to vaccinate.
So what`s very clear is that measles infection had a huge impact on not just Max`s life, but on many aspects of his family's lives too. That's the case with any serious infectious disease. Or any kind of chronic illness.
That's genuinely the reality, but we don`t hear stories like Max`s often nowadays. That fact is really a testament to how effective measles vaccination campaigns actually are. A common refrain in medical and scientific circles is that vaccines are victims of their own success.
What that means is, it is said in antivaccine groups that vaccines are not needed because nobody gets diseases like measles, rubella, polio etc. anymore. Therefore the risk of infectious disease is seemingly low. Furthermore, if you are infected with viruses such as measles, it is not likely to be severe. However both of these observations are because vaccines are so effective.
So what makes stories like Max`s, and similar ones, all the more tragic is that they are completely avoidable with vaccination. But with vaccine hesitancy on the rise, more and more measles infections are occurring globally.
2. Measles Epidemiology
An article published on 29th March 2023 in the Offaly Independent states that parents are“urged to protect children against measles as cases rise worldwide.” It goes on to state that already in 2023, measles outbreaks have been reported in countries such as the United States, South Africa, Nepal, and Austria. And it`s not only Irish organisations like the Offaly Independent that are taking note. International organisations are too. UNICEF noted in a 2022 article that “Measles cases are spiking globally.” The article begins with the startling statistic that “The number of reported worldwide measles cases has increased by 79 per cent in the first two months of 2022 compared to the same time last year.”According to the CDC, even though measles was declared eradicated from the United States in 2000, almost 1,300 cases were reported in 31 states in the United States in 2019 - which happens the be the largest number of cases since 1992.
There`s no denying it. Measles is back. Which means more infections. More longterm complications. More stories like Max`s. And more families around the world left torn apart. That`s unless we do something.
3. What measles is, and why it isn`t mild
Putting on my microbiologist hat for a moment, what actually is measles? Well, it's a virus. Further, it`s not just any virus, it's one of the most infectious viruses ever known. The first written account of the disease was published as early as the 9th century by a Persian physician . In 1757, a Scottish physician called Francis Homes demonstrated that measles was caused by an infectious agent (ie. the virus) that was present in the blood of patients. In 1954, the virus causing measles was isolated in Boston in Massachussetts by John F. Enders and Thomas C. Peebles. The virus was isolated from the blood of 13 year old David Edmonston. Further, outbreaks took place in Faroe islands in 1846, Hawaii in 1848, Fiji in 1875, and Rotuma in 1911.
Moreover, according to the CDC website, in the decade before 1953 when a vaccine was available, almost all children contracted measles by the time they were 15 years of age. It is estimated that 3 to 4 million people in the United States were infected with measles every year. Further, every year, an estimated 400-500 infected people died, 48,000 were hospitalised, and 1,000 suffered encephalitis
Why has measles caused, and continue to cause, such devastation? It has an R0, or reproductive number, of 12 to 18. What that means is that every infected individual will pass the virus on to between 12 and 18 other people. For comparison, SARS-CoV2 (the virus causing COVID-19) is between 2 and 3. Even the dreaded Ebola virus has an R0 of only between 1 and 4. In any table of the most infectious diseases you look at online, measles will be at the top, or very near it. It's always within the top 5.
4. Measles symptoms and severe side effects
Symptoms generally start showing within 10-15 days of initial exposure to the virus. Symptoms include general cold-like symptoms including a sore throat, runny nose, sneezing, lethargy, dry cough, and a fever of 38 degrees Celsius or above that may reach 40 degrees, and inflamed eyes (conjuctivitis). Measles also causes tiny, characteristic greyish-white spots with a blue centre found in the mouth. These are called Koplik's spots, or Koplik`s sign. They usually occur 2 to 3 days before the measles rash itself. This generally is seen as large, blotchy skin rashes that often flow into each other
That's not so bad, right? A fever, rash, sore throat, a bit of a cough, some funny-looking spots in your mouth, a rash. Minor inconveniences. Par for the course right? It will probably clear itself up relatively quickly, right?
As many as 1 in 5 unvaccinated people are hospitalised when infected with measles.
And according to the CDC website, pneumonia occurs in as many as 1 in every 20 children who become infected with measles. Not only this, pneumonia is the most common cause of death among children who become infected with measles.
If you contract it while pregnant, it can cause miscarriage or stillbirth, premature birth, or a low birthweight.
There's also the possibility of more severe symptoms such as subacute sclerosing panencephalitis (SSPE) that occurred in Max`s case. SSPE is always fatal and there is no cure.
I`ll say that again
Measles can also cause intellectual disability, seizures, and deafness. Which, as described above, has a profound effect on every aspect of the patient`s life, as well as that of their family. And because SSPE, pneumonia, and neurological complications are often fatal, nearly 1 to 3 of every 1000 children who become infected with measles will die from respiratory or neurologic complications.
So I`ll ask again.
Does measles sound mild?
I like to use this analogy. Would you rather stand 10ft or 100ft away from the edge of a dangerous cliff? You`re away from danger in both cases, but you significantly reduce the risk of harm in the second scenario. So I personally would take the second option any day. That's what taking vaccines is like.
5. The measles vaccine
An article published on 22 February 2023 by the World Health Organisation (WHO) stated that measles vaccination has saved over 56 million lives globally since 2000. Further, from 2000 to 2021, the annual number of measles deaths has decreased by 83%, from 761,000 to 128,000. The final measles death occurred in the United States in 2015. Vaccines continue to save millions of lives every year. However, it is still present in many other countries and can be transmitted by unvaccinated travellers, and can cause outbreaks that are costly to control.
That said, the impact of measles vaccination has not been small, and the WHO has set equally ambitious targets for the future. Their goal, in collaboration with countries and partners, is to save another 50 million lives by providing access to essential vaccines by the end of 2030, with measles vaccines contributing a large percentage to it. It isn`t just the World Health Organisation either. The CDC works with partners all over the world to eliminate measles as well as rubella, to protect everyone, but especially children, from these deadly diseases. Further, the CDC invests globally in reducing the global health burden of these diseases. This saves millions of lives, reduces healthcare costs, and minimizes economic impacts on families and society.
6. Side effects of the vaccine
Now, it wouldn`t be fair not to pay heed to the fact that vaccines can and do have side effects. All medications and medical procedures carry some degree of risk. We can never predict what response any given person is going to have to a given medication/procedure with 100% accuracy. There are far too many variables between people. Vaccines are not different.
It is true that not everyone can have a measles vaccine. I stated in an earlier article that, according to Dr. Gretchen LaSalle, family physician, vaccine hesitancy expert and author of Let`s Talk Vaccines, those who are immunosuppressed cannot be given live vaccines. This is just one example. For example, as we age, the function of our immune system weakens. This is a phenomenon that immunologists call “immunosenescence.”For many viruses and other pathogens, the elderly experience the most severe forms of disease..
As you would expect, immunosenescence also causes a weakened response to vaccination. Vaccines rely on the immune system to launch a strong response to a whole pathogen, or a portion of a pathogen. Therefore, vaccines are less effective in elderly patients. So, clearly, a vaccine cannot be 100% effective in everyone.
It`s clearly established that the MMR vaccine is very safe, and most side effects are mild and do not last long. However, vaccines, like any medication, still carry the risk of side effects. The side effects of the MMR vaccine are similar to those of many other childhood vaccines. According to the NHS website, these include redness and swelling at the injection site. The website also states that just over a week following vaccination, babies or young children might feel unwell and experience a high temperature for 2 to 3 days. Some children also cry or become upset following vaccination, which is to be expected and should feel better after reassurance and a cuddle.
Further, it is important to note that the MMR vaccine does not cause autism.. The original 1998 study linking them has now been retracted, and the lead author has been discredited and had his medical licence revoked, and 10 of the other authors have retracted their names from it. I wrote an article about this, which you can read here.
Many large scale studies have been carried out since then, and none have found any association between the triple dose MMR vaccine and autism.
Infectious disease has an impact on many aspects of the lives of those affected by it and their families. It is the same for any chronic illness. We do not often hear stories of how infectious disease impacts people's lives anymore. That is really a testament to how many people's lives have been saved by measles vaccination, and in turn how effective measles vaccination is. Therefore I stand firmly behind the effectiveness of vaccination, and all public health measures. There is no real debate around vaccines. There is, however, a discussion to be had around people's perceptions of vaccines. Not only this, but about building trust in the healthcare systems more broadly.
That said, the truth is that no medication is ever 100% effective in 100% of people, and all carry some degree of risk. Due to the concerns around side effects from vaccination, I do think that communicating these caveats to people is important. The reason for that is one simple word. Trust. People won`t accept measures if they don`t trust them. Public health involves, well, the public. It's right there in the title. If people believe they are going to experience devastating side effects from vaccines
However, compare that to the devastating effects of contracting the infectious disease and it becomes clear why I and people like me are advocating for vaccines and other healthcare interventions.